急症腹腔镜胆囊切除术中转开腹的危险因素分析

Risk Factor Analysis of Emergency Laparoscopic Cholecystectomy Hemi-Colectomy

目的探讨急症腹腔镜胆囊切除术中转开腹的危险因素。方法回顾性分析4年内于成都市第五人民医院行急症腹腔镜胆囊切除术480例患者的临床资料,记录患者一般资料、合并疾病、手术及围手术期相关资料、化验指标、住院情况等基本资料,对可能导致中转开腹的因素进行单因素分析,在对所有因素综合进行Logistic多因素回归分析。结果共有45例患者在腹腔镜胆囊切除术中中转开腹;单因素分析中显示年龄、胆囊炎发作时间、上腹部手术史、合并糖尿病、营养程度、胆囊壁厚度、白细胞计数、总胆红素水平、谷丙转氨酶水平、术者技术水平和手术出血量等均为急症腹腔胆囊切除术中转开腹的危险因素;Logistic多因素恢复分析结果显示年龄、胆囊壁厚度、合并糖尿病、胆囊炎发作时间、术者技术水平为中转开腹的独立危险因素。结论急症腹腔镜胆囊切除术中转开腹的独立危险因素有年龄、胆囊壁厚度、胆囊炎发作时间、合并糖尿病和术者技术,应提高医师技术水平、尽早手术,对老年、胆囊壁较厚和合并糖尿病患者手术应格外谨慎。

Objective To investigate the emergency laparoscopic cholecystectomy cause hemi-colectomy risk factors. Meth- ods A retrospective analysis of clinical data of 480 cases in recent four years in our line emergency laparoscopic cholecystectomy was conducted, record patients general material, merge disease, surgery and perioperative related material, assay index, be in hos- pital situation basic material, may lead to hemi-colectomy factors of single factor analysis, in the all factors for Logistic multiple factors regression analysis. Results A total of 45 patients in the laparoscopic cholecystectomy hemi-colectomy;single factor anal- ysis showed that age, cholecystitis attacks on time, abdominal, surgery history, with diabetes mellitus, nutrition degree, gallbladder wall thickness, white blood cell count, total bilirubin level, cereal third transaminase level, reader technical level and the operation amount of bleeding, etc were all risk factors of emergency celiac when cystectomy hemi-colectomy; Logistic multi-factor recovery a- nalysis results showed that age, gallbladder wall thickness, merger diabetes, cholecystitis attacks time, and reader technical level Were independent risk factors for hemi-colectomyl Conclusion Emergency laparoscopic cholecystectomy hemi-colectomy inde- pendent risk factors were age, gallbladder wall thickness, cholecystitis attacks time, with diabetes mellitus and reader technology, we should improve physicians technical level, the operation should be as soon as possible, the elderly, gallbladder wall thicker and complicating with diabetes should be particularly careful in operation.